Individual
MADELEINE SUZANNE BULLICK GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
3710 SW US VETERANS HOSPITAL RD, PORTLAND, OR 97239-2964
(503) 220-8262
Mailing address
1231 NE MLK BLVD APT 523, PORTLAND, OR 97232-2095
(651) 212-1706
Taxonomy
Speciality
Code
Description
License number
State
1835P1300X
Psychiatric Pharmacist
Primary
RPH6254
ND
Other
Enumeration date
09/23/2022
Last updated
09/23/2022
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